Tips for fourth-years

If at first you don’t match, what’s next?

Not matching is a major disappointment, but there are steps you can take to make the experience less painful.


It’s Match day. You’ve finished your interviews, submitted your rank order list and you’re ready to find out where life will take you next. You’ve been trying to stay calm as you wait for this news.

But instead of discovering which program you’ll be entering in July, you learn that you didn’t match.

This is the fate of many DO and MD students every year. While it can be an unsettling experience, not matching doesn’t mean you won’t be placed into a residency program and go on to have a successful career. There are several steps students can take—before, on and after Match day—to make the experience of not matching less painful.

Prepare a game plan

Most students who don’t match will participate in the AOA Post Match process, also known as the scramble, in which they contact and interview with residency programs that have unfilled positions, or, if they participate in the National Resident Matching Program, the Supplemental Offer and Acceptance Program (SOAP).

Having a plan in place for participating in these programs is a wise idea, says Sonbol Shahid-Salles, DO, MPH, a member of the AOA’s Bureau of Emerging Leaders. “Hopefully you are going to match, but if you don’t, you’ll have a game plan,” she says.

Dr. Shahid-Salles and Shaun Notman, DO, suggest students take the following steps to prepare for Match day:

  • Make sure you have time set aside on Match day for sending emails, making phone calls and meeting with a student advisor.
  • Make a list of your contacts: Interns, residents and faculty you’ve encountered in your clinical rotations. They may be able to provide guidance as you search for programs.
  • If you’re participating in the AOA Match, set up draft emails to potential programs that can be personalized and sent if you learn that you didn’t match and the program has an open slot.

Keep calm and focus on the next step

“On Match day, there’s no time for grieving or wondering if there’s anything you could have done differently,” says Dr. Notman.

As a fourth-year student in 2013, Dr. Notman reacted quickly upon learning he didn’t match in orthopedic surgery. He lined up a traditional rotating internship within hours of receiving the news. Now, he’s finishing up a family medicine residency and getting ready to enter a sports medicine fellowship in South Miami, Florida, which will allow him to fulfill his dream of working with athletes.

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Meet with your student affairs department

The first thing to do after learning you didn’t match is to meet with your school’s student affairs department as soon as possible, says Angela Bacon, the director of student services for the Oklahoma State University Center for Health Sciences College of Osteopathic Medicine in Tulsa.

“On Match day, we meet with unmatched students at the earliest hour we possibly can, and we start putting a plan together for each student,” she says.

Consider positions nationwide

“When students come in and they don’t match, we tell them to keep their options open,” says Bacon. “Geographically speaking, this is especially important. They need to open up their window of possibilities.”

Go for clinical experience

After not matching, some DOs take time off to do research or pursue other training, such as an MBA. Bacon advises against this approach.

“For residency placement, graduating medical students are often given first priority over second-season physicians,” she says. “I advise students to make sure they have exhausted every single option before they start thinking about an MBA or a research year.”

Family medicine programs usually have more open slots, Bacon notes. Some students may not be very interested in pursuing family medicine, but gaining the clinical experience is a better choice than taking the year off, she says.


  1. Do surgeon

    This article is ok if you want to end up in family medicine or internal medicine.

    As a current surgery resident and DO at a university surgery residency I do not agree with several points of the article.

    First, you didn’t match. Time to get into the soap and see if you can get an offer for a position. You need to clarify your goals and figure out ASAP why you didn’t match so when you interview you can answer this question in your interviews.

    If you want a surgical sub specialty, doing research at a connected institution that has placed people into residency will be much better than pursuing an internship. Additionally, I would recommend against pursuing an osteopathic TRI. You’ll want to get an ACGME surgical preliminary year and get some good LORs, reapply for your specialty or general surgery.

    Research years if you get publications and letters of Recommendation from known faculty will get you into a program. Research if funded is the best way since you get a lot more flexible schedule with respect to interviews.

  2. Thomas John D'Amico, D.O.

    What’s happening obvious. This is a back door way to fill the void of primary care FM physicians in the US. Sorry folks, the healthcare system can only support so many orthopedic surgeons, dermatologists, anesthesiologists and emergency room physicians. After all, isn’t this what the Affordable Care Act promised? More patients covered with crappy insurance to go along with disgruntled physicians who didn’t match in any other specialty than family medicine? Think harder next time you cast your vote for president.

    1. Michael

      This is what millenials wanted right? They supported Democrats and Obamacare, and what does Obama do once in office? He stabs them in the back, and cuts GME funding. Oopsie. I guess students thought they themselves personally would not be affected and they’d be automatically getting their ROAD to happiness specialty. Your advice won’t be said by any academic med school administrator but it’s completely right. Kudos. Elections have consequences.

  3. John E. Kazilionis, D.O., FACOFP

    After 40 years in Family Medicine, I can say this career path is wonderful. I did OB/Gyn, Orthopedics (non-surgical), ENT, Peds, Internal medicine, geriatrics, psych, G.I, endocrinology, dermatology, OMM, cardiology, some ER moonlighting early on, Pulmonology, nephrology, neurology, urology, lots of skin surgeries and became quite adept at identifying and removing skin cancers, to include doing plastic repairs on the face. Skin grafting was also something I did with diabetic ulcers.

    The truth is that a well trained family medicine physician is a real specialist because they do so many things exceptionally well. The key is not to do something you are not competent to do. But you can get training to so most things very well. Some people speak like family medicine is a last ditch career for people who can’t make it in a specialty. These people do not know that family medicine is the toughest speciality because family docs need to know more about everything than for example a pulmonologist, or cardiologist, or orthopod.

    1. Watson

      Numbers don’t lie.
      Family Medicine and Internal Medicine are extremely tough specialties. To be good at it you need to know a lot and be very good at it.
      Unfortunately, when a student does not match into their program of choice, which specialty do they end up in? Family Medicine.
      So, it is the last resort and it is easily availablle when they are scrambling. This does not mean that Family Medicine is inferior but it is a “last ditch” option for a lot of people who are unable to match.
      The important question that needs to be addressed is why are these students not matching into their programs of interest.

      1. Robert

        Unmatched students should consider Pathology. It’s a great specialty to enter and does not require an internship year. You get to see and learn all the pathologic diagnoses and are vitally important to patient care.

    2. Cynthia Martin

      You are absolutely correct
      & point on in your Reply
      Family medicine Doctors
      Have to know a very broad
      Knowlege base rather than a specialty Doctor
      Thank you for your reply Doctor

  4. Keith Frederick, D. O.

    There is another option for those who don’t match. I’m a DO and a member of the Mo House of Representatives where I sponsored legislation which established a new category of licensure, the Assistant Physician. This law allows a doctor who doesn’t match, to practice under a collaborative practice agreement with a licensed physician. You must practice in an underserved area in primary care. This passed 2 years ago and the rules and regs are nearly completed which will allow physicians who graduated within 3 years to apply for this license. For many who don’t match, this will allow them to use and advance their skills, make an income, and provide much needed health care.

    1. John W. Becher, DO

      The American Osteopathic Association (AOA) remains concerned with this approach, allowing medical school graduates to provide independent patient care under limited supervision. Medical school graduates are not prepared or trained to provide independent care to patients. They require continuous direct supervision, as provided in postgraduate residency training, as they continue to develop the skills and knowledge needed to deliver high-quality, comprehensive patient care.

      If the goal is to address primary care workforce shortages, opportunities do exist for unmatched medical school graduates to place in a primary care residency if they have an interest and the appropriate qualifications. Therefore, states should instead focus on funding programs that encourage medical school graduates to pursue primary care specialties, particularly in rural and underserved areas. Programs like physician loan repayment/forgiveness and Medicaid payment parity for primary care services are examples of proven strategies. This is the best way to create fully-trained and licensed physicians equipped to safely handle the complex primary care needs of patients while addressing workforce shortages in rural and underserved areas.

      1. Michael

        Yes, but the point is you guys aren’t doing that. Yet, NPs can fully practice family practice without even doing a residency and the healthcare system accepts them, yet med students w/more education and more debt, can’t do anything? Whose fault is that then? Don’t blame Dr. Frederick for actually solving the problem, while med schools and the GME machine continue to spin their wheels.

    2. Zarmina Amin


      Can you please advise where I can apply for this licensing. I have applied for residency for the past two years and have been unsuccessful. Please contact me on my email. I would greatly appreciate it and I’m highly interested in this licensing. I have listed my email address below.

    3. Narin

      @ Keith Fredrick : Hello, I am also interested to know about this license for assistant physician. Would you please advice me where to apply for this? I will sincerely appreciate your help.

    4. W. Lanham

      You go guy. The U.S. will continue to suffer the highest medical care costs on Earth unless our legislatures seize control of licensure from the medical establishment.

  5. Pingback: Should you Scramble into Family Medicine? - FM Student

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  7. JIMMy

    Can you help a depressed Airforce veteran and medical graduate who didn’t match today, hopefully I can find work with a limited license, your help will be greatly appreciated and not forgotten.

    1. FKhan

      Hi, my brother is in same situation as you (2017, no match). This is the 3rd year in a row. :(

      Can some please help us out, share contacts or tip off on any vacancies?

  8. Fredricks DO

    As a former anesthesiology resident who saw the light and quit to do a family medicine residency I can tell you that there is no perfect path to find a fulfilling career in medicine. I know a lot of disgruntled physicians who matched the first time and then wished they had done something else.

    I am grateful for my rotating interniship year.

    To the point of you are not ready to practice medicine after 4 years of school, I say really? Sounds like an ABMS pitch to keep their current scheme of BC and MOC alive. I started moonlighting after my internship year in 6000-12000 volume EDs. In fact my grandfathered FP residency director demanded that we moonlighted or we would not pass residency.

    If you are not prepared to function well in 90% of the situations that a GP faces after you graduate you have failed your education. I say that as a DO educator. A little uncertainty, a little hesitation, sure, but as has been pointed out, PAs and Nurse Ps do it with 1/2 our education.

    I also have a friend who was an FP for 5 years before he hung it up and retrained as a urologist. Again there is no set path to a perfect career.

    So for those who didn’t match quit listening to peers and residents, contact your attending mentors and discuss a strategy with them. I personally feel that every DO should do their first post doc year as a rotating intern. For the surgeons it will make you appreciate the nug work of medicine for the medicine folks you will learn to use your hands.

    I’d end by saying that I write this from Port au Prince where I just finished a week working in a missionary hospital. The FP that runs it does spinal blocks in their OR when needed and is a great diagnostic ultrasonographer. Point is that he cares for patients and changes their lives and uses skills introduced to him during internship and refined via practice and thoughtful research.

    Skills every good DO should know how to use upon graduation.

    So the question you need to ask is what is your motivation: healing the sick or focusing on a single residency you may grow to hate in 10 years?

    As disappointing as a match failure is right now you might have just been blessed with an opportunity to find your more perfect path. Embrace it and work the problem. It will work out if you remain steadfast and use all your resources.

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